[Free dermal fat graft for coverage of the median nerve following failed carpal tunnel release].
OBJECTIVE
We wished to evaluate the effectiveness of a free dermal fat graft for covering the median nerve in order to improve function after failure of carpal tunnel release.


METHODS
Eight patients with nine failures of carpal tunnel release were reviewed for this retrospective study. They all had significant perineural fibrosis. We performed a free dermal fat graft harvested from the inguinal region on the same side. The mean follow-up was 37 months (range 6 to 112). All patients had a clinical examination, a disability arm and shoulder scoring (DASH) and magnetic resonance imaging (MRI).


RESULTS
Five patients were satisfied or very satisfied with the procedure although only two patients returned to work. Mean grip strength was 13 kg (43% of non-operated hand) and the two-point discrimination test was normal or subnormal six times on the eight wrists tested. The mean DASH score was 43 out of 100. MRI scans on eight wrists showed a fat signal in all patients and enhanced signal with gadolinium contrast in six cases.


CONCLUSIONS
Free dermal fat graft offers a good covering for the median nerve over the carpal tunnel in cases of failure of carpal tunnel release. MRI showed viability of the graft. Clinical results show improvement but symptoms of median nerve irritation persisted. Permanent intraneural changes may explain these limited results.
Wallach
F
F
Centre de la main, CHP Saint-Grégoire, 6, boulevard de la Boutière, 35760 Saint-Grégoire, France. fabien.wallach@free.fr
Richou
J
J
Genestet
M
M
Le Nen
D
D
D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D002349:Carpal Tunnel Syndrome / Q000601:surgery*; D005260:Female; D005355:Fibrosis; D018737:Hand Strength; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000601:surgery*; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult